Part 3 of a series
In the first two blog posts in this series we looked at the general case for establishing a remote patient monitoring (RPM) program, and then how Trinity Health At Home created its specific program. There is one more key element that is essential for success, however – getting buy-in from providers and patients.
No matter how brilliantly designed a program is, no matter how sophisticated the technology behind it is, no matter how much money the executive team or C-suite puts behind it, the simple fact is an RPM program won’t work if it isn’t being used. Trinity Health At Home understood this principle and went to great lengths to ensure both providers and patients understood the potential benefits and became fully engaged in it.
Bringing physicians and nurses on-board
For clinicians, the primary motivator in the adoption of new technologies is how it will help improve their ability to drive better health outcomes for their patients.
Clinicians are often frustrated by new technologies and workflow changes that create extra work without delivering additional value. Trinity Health understood this, and so worked with Vivify to educate clinicians on how the RPM program could help them become more efficient while helping their patients achieve one of their biggest health goals – staying at home and out of the hospital.
Trinity Health also understood that having willing participants among the staff was key to success. Since their roles would be changing, Trinity Health had all staff members re-interview for their jobs to be sure they would have the right people in place to launch the program.
Once staffing was set, they were shown how to use the technology to monitor patients and what the process should be if something was going wrong with a patient. They were also taught how to make and receive virtual calls. This included not just how to turn the camera on and off, but how to best take advantage of these calls to gather more information (such as moving the camera around to check on the status of equipment.) They were also shown how the RPM program would help them work just as effectively with patients while eliminating much of the normal travel time to patients’ homes, making it possible for them to help more patients more efficiently.
Since the nurses in the Trinity Health At Home program would be working from home, in some cases they had to beef up their personal technology, such as installing high-speed wi-fi so they could use the portals, improving security to meet Health Insurance Portability and Accountability Act (HIPAA) requirements, or adding a webcam if their tablet didn’t have a camera.
Physicians were also shown how technology could help them unclog overloaded waiting rooms and reduce their own workloads while increasing patient satisfaction and health. Many patient needs that start out small could be handled virtually, such as reminding a patient with congestive heart failure (CHF) to take a water pill if they showed a sudden weight gain overnight.
Fewer office visits meant more time to work with those patients who needed more attention, and more time to get to know the stories behind the patients in order to drive better outcomes.
Ensuring participation from patients and caregivers
Compliance, of course, represented the greatest challenges. Hospitals and health systems have levers they can pull to improve compliance. If it is to be successful, patients must be educated on the health and wellbeing benefits of program participation.
Trinity Health At Home begins generating enthusiasm among patients and caregivers while the patient is still in the hospital. The home care coordinator explains that the patient’s doctor thought that the patient should participate in the program, and shows a video that explains the Trinity Health At Home program and how it works and then how to use the tablet.
The video shows a patient doing a care pathway, answering questions on the tablet, and taking his or her own vital signs. The home care coordinator then demonstrates how easy it is to take readings using the supplied equipment and to use the tablet to answer simple questions such as how the patient is feeling that day.
Once the patient is intrigued, the home care coordinator asks for consent to participate in the Trinity Health At Home RPM program. By that point, very few patients decline to give it a try. In fact, most look forward to participating, especially when they understand that using it on a daily basis can help them stay at home longer and remain out of the hospital.
When the patient goes home, Trinity Health At Home schedules a nurse visit to not only help the patient get settled in, but also to bring and set-up all the RPM equipment, make the wi-fi and Bluetooth connections, and show the patient and/or caregiver how to use the equipment and report results in more detail. The nurse can answer any additional questions and ensure that the patient has everything needed for the program to operate smoothly.
One of the advantages of this program is that everything patients need to do is pushed to them each day. They don’t have to think about what button to push next; the technology walks them through it the way a setup wizard walks computer users through an installation.
Another advantage is the education it offers, empowering patients to make significant lifestyle changes that improve their health. The RPM program includes 8 weeks of automated digital conversation aligned to the care pathway the patient is on. The more the patient learns, the more compliant the patient becomes, ultimately driving better outcomes.
Finally, the way the RPM program is presented, patients feel that the nurses they work with for virtual care are part of Trinity rather than being outside contractors. This helps strengthen the relationship between the patients and the Trinity Health At Home staff and reinforces the idea that it is a total healthcare solution.
The results have been astounding. Trinity Health At Home has a 90% compliance rate all the way through the program. The patients seem to enjoy seeing their readings each day, and the numbers provide an incentive to stick with their care program because they want to be sure they get good readings.
Caregivers like it as well. As one put it, “I feel like there’s an angel watching over them.”
How much is the virtual call capability being used? Over the course of the program, there were 30,261 virtual calls made, which together resulted in 165,786 minutes (2,763 hours) of virtual care, with each call averaging 5.5 minutes. Of those, more than 6,000 were initiated by nurses who saw an issue and made a preemptive virtual call lasting an average of 6 minutes for a total of 36,966 minutes (616 hours).
Adjusting for patient needs
Typically, the RPM program runs for 60 days. If the patient has a low-risk health score at the end of that period, they are done with the program. But if, in the opinion of the care team, the patient remains at high risk of readmission, the RPM program can be extended for another 60 days – and even 60 days beyond that if-needed. It’s all about driving the proper outcomes.
Clearly, the Trinity Home At Health program is working. In the final blog post in this series, we will look more closely at the Return on investment(ROI) and a few lessons that were learned along the way.